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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Device-modified trabeculectomy for glaucoma.

Xue Wang1, Rabeea Khan, Anne Coleman

  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, USA, 21205.

The Cochrane Database of Systematic Reviews
|December 2, 2015
PubMed
Summary
This summary is machine-generated.

Glaucoma surgery using devices like Ex-PRESS or amniotic membrane may slightly lower intraocular pressure (IOP) one year post-surgery. However, evidence quality is low, and safety remains unclear, necessitating further research.

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Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Glaucoma Management

Background:

  • Glaucoma is a leading cause of irreversible blindness worldwide, characterized by optic neuropathy.
  • Current primary treatment involves lowering intraocular pressure (IOP) through medications, laser, or surgery.
  • Trabeculectomy is a common glaucoma surgery, with device-modified approaches aiming to enhance aqueous humor drainage.

Purpose of the Study:

  • To evaluate the effectiveness and safety of devices used with trabeculectomy versus standard trabeculectomy for glaucoma.
  • Primary outcomes include IOP control and surgical safety.
  • Comparison of various adjunct devices such as Ex-PRESS, Ologen, amniotic membrane, E-PTFE, and Gelfilm.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Comprehensive literature search across multiple databases (CENTRAL, MEDLINE, EMBASE, PubMed, LILACS, mRCT, ClinicalTrials.gov, WHO ICTRP) up to December 2014.
  • Inclusion criteria focused on RCTs comparing device-assisted trabeculectomy with trabeculectomy alone, including studies with antimetabolites.

Main Results:

  • Thirty-three studies with 1542 participants were included, comparing five types of devices with trabeculectomy alone.
  • Low-quality evidence suggests Ex-PRESS devices may slightly reduce IOP and complications like cataract surgery and hyphema.
  • Low-quality evidence indicates amniotic membranes may lower IOP and reduce hypotony; Ologen showed uncertain effects on IOP.
  • E-PTFE showed no significant IOP difference but reduced hypotony; Gelfilm data were inconclusive.

Conclusions:

  • Device-assisted trabeculectomy may offer greater IOP reduction at one year, but evidence quality is low due to potential biases.
  • Ex-PRESS devices and amniotic membranes show potential for slightly better IOP reduction compared to trabeculectomy alone.
  • The safety of these devices compared to standard trabeculectomy is unclear.
  • Limitations in study design and conduct impact applicability; further research is needed for various devices and populations.